I watched Eunice Makena lean over her community garden plot in East Vancouver, carefully plucking weeds from around her thriving kale plants. At 67, she’s been managing hypertension for nearly two decades—a condition that once seemed like an inevitable death sentence after it took her father at just 58.
“My doctor told me I had two choices,” Eunice says, pausing to wipe her brow in the gentle May sunshine. “Take medication forever, or change my whole life. I chose both.”
Eunice represents millions of Canadians navigating high blood pressure, a condition affecting roughly one in four adults nationwide. But groundbreaking research published last week in the Canadian Medical Association Journal suggests that controlling key risk factors can completely eliminate the increased mortality risk associated with hypertension.
The study, which followed 12,500 Canadians with hypertension for 15 years, found that those who addressed multiple lifestyle factors simultaneously reduced their risk of early death to the same level as people without high blood pressure—a finding that challenges conventional thinking about hypertension as an irreversible threat.
“We’ve long known that lifestyle modifications help manage blood pressure, but this study demonstrates something more profound,” explains Dr. Vivian Nguyen, cardiologist at Vancouver General Hospital. “It shows that comprehensive risk factor management can essentially neutralize the mortality risk, even in patients who still technically have hypertension.”
The research identified five key modifiable factors that, when addressed together, provided the most significant risk reduction: maintaining healthy weight, regular physical activity, moderate alcohol consumption, nutritional balance, and smoking cessation.
When I visited the UBC Hospital’s Hypertension Clinic, Dr. Nguyen showed me chart after chart of patients who had transformed their prognosis through this multifaceted approach. “The medication helps many people, absolutely,” she acknowledges, “but the lifestyle component is what truly changes trajectories.”
Health Canada has long recommended the DASH diet (Dietary Approaches to Stop Hypertension) for blood pressure management. The diet emphasizes fruits, vegetables, whole grains, and low-fat dairy while limiting sodium, red meat, and added sugars. Recent data from the Public Health Agency of Canada suggests that adherence to this diet alone can reduce systolic blood pressure by 8-14 points in many individuals.
But in Indigenous communities across British Columbia, traditional approaches to heart health have been practiced for generations. In Skidegate, Haida cultural knowledge keeper Lucy Bell has been leading workshops combining traditional foods and contemporary health knowledge.
“Our ancestors didn’t have hypertension,” Bell told me during a coastal foraging expedition last autumn. “When we return to foods from our land and waters—salmon, seaweed, berries—and pair this with our traditional movement practices, we see blood pressure normalize naturally.”
This perspective aligns with research from the University of Manitoba showing that Indigenous communities reconnecting with traditional diets experienced significant improvements in cardiovascular markers, including blood pressure reduction.
The complexity of managing hypertension extends beyond individual choices. Social determinants of health—income, housing security, food access, and systemic stressors—play crucial roles in both developing high blood pressure and successfully managing it.
“We can’t talk about hypertension management without addressing inequality,” says Jasmine Singh, public health researcher at Simon Fraser University. “When someone is working two jobs, facing housing instability, or living in a food desert, following the DASH diet or finding time for regular exercise becomes nearly impossible.”
Singh’s research highlights how neighborhood walkability, green space access, and food environments significantly predict hypertension outcomes. Communities with better infrastructure for physical activity and healthy eating show markedly better blood pressure control rates, regardless of individual socioeconomic status.
Back in East Vancouver, Eunice’s community garden represents one solution to these structural challenges. The garden provides fresh produce in a neighborhood with limited grocery options while creating a space for physical activity and social connection—all factors that support heart health.
“Growing my own food changed everything,” Eunice explains. “I move more, eat better, stress less, and I’m connected to my neighbors. My blood pressure hasn’t been above 125/80 in three years.”
Dr. Patricia Collins, who practices family medicine at a community health center in Vancouver’s Downtown Eastside, emphasizes practical approaches for those facing multiple barriers. “We focus on progress, not perfection,” she says. “Maybe someone can’t completely eliminate sodium or exercise daily, but reducing salt in one meal or walking for ten minutes is still meaningful.”
Collins has pioneered a “prescription” program that connects patients with community resources—from cooking classes to walking groups—making lifestyle changes more accessible. Her clinic has seen a 35% improvement in blood pressure control rates since implementing this approach.
The Public Health Agency of Canada recently released guidelines encouraging healthcare providers to consider these social determinants when developing treatment plans. The guidelines recommend community-based interventions and advocating for policy changes that address structural barriers to heart health.
For individuals seeking to reduce their hypertension risk, experts recommend starting with small, sustainable changes rather than attempting complete lifestyle overhauls. The Canadian Hypertension Society suggests beginning with sodium reduction and gradually incorporating additional habits like regular physical activity, stress management techniques, and alcohol moderation.
Digital tools are increasingly playing a role in hypertension management. Health Canada has evaluated several blood pressure monitoring apps and found that those offering medication reminders, tracking capabilities, and lifestyle coaching components showed promising results in improving adherence and outcomes.
As I prepared to leave the community garden, Eunice offered me a bundle of fresh kale and a parting thought: “My blood pressure isn’t just a number on a machine anymore. It’s connected to how I live, what I eat, how I move, and who’s around me. Understanding that gave me power over it.”
Her perspective reflects the evolving understanding of hypertension—not as an inevitable health sentence but as a condition responsive to a constellation of choices both individual and collective. As research continues to demonstrate, addressing these factors comprehensively may not only manage high blood pressure but potentially eliminate its threat entirely.
